YWCA - WE 360° Jr. Registration Form

YOUR NAME*

MS. / DR. ETC.FIRST NAMEMIDDLE / INITIALLAST NAMEJR. / III / ESQ / ETC.

YOUR EMAIL*

YOUR MAILING ADDRESS*

STREET ADDRESS OR PO BOX

Street Address Line 2

CITYSTATE

ZIP CODE

YOUR PHONE NUMBER*

AREA CODEPHONE NUMBER

YOUR CURRENT ENTREPRENEURSHIP STATUS*

I have a businessI want to start oneI'm interested in learning more

YOUR INDUSTRY (FOR WE 360° JR. RECORDS ONLY)

YOUR RACE (FOR WE 360° JR. RECORDS ONLY)*

YOUR AGE (FOR WE 360° RECORDS ONLY)*

16-1819-22

YOUR AGE (FOR WE 360° RECORDS ONLY)*

YOUR GENDER (FOR WE 360° JR. RECORDS ONLY)*

YOUR PREFERRED PRONOUN (FOR OUR RECORDS ONLY)*

WERE YOU REFERRED BY ANOTHER YWCA?

IF YES, WHICH ONE?

COMMENTS (IF ANY)

YOUR DESIRED SESSION*

WE 360° JR. PRE-SURVEY